Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Painful Thinking

Painful Thinking

“Executive functions” is a global term that is used to describe our cognitive skills: our ability to attend, concentrate, remember, make decisions and exercise judgment. These cognitive skills enable us to be effective in our daily routines. Cognitive skills are among the most severely impacted with dementia such as Alzheimer’s Disease. It also occurs in chronically painful conditions.

When injured individuals appear to be compromised in these areas, we assume that this is due to the effects of their sleep deprivation, anxiety, fatigue, medication or depression. And, in fact, thse factors do impact executive functioning.

However, the greatest impact upon executive functioning comes from chronic pain.

Research in fibromyalgia for example, demonstrates that while all of the above factors interact to impair executive functioning among those in pain, it is pain itself which accounts for the preponderance of impaired cognitive skills.

When we note that patients are inconsistent, forgetful, unable to track medication, fail to understand what they are told or are “non-compliant”, consideration must be given for the global and significant impact arising from the pain itself.

Thus, when we note that a patient has multiple behavioral indicators of pain, we should be prepared for the patient’s impaired cognition.

This can be addressed by having offices provide patient with reminders of appointments, written statements of their condition, written instructions as to how to participate in their own rehabilitation and having, where possible, a friend or family member, assist the patient with tracking medication intake and refills.